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Comprehensive Patient Care > Acute Setting Key Concepts > Flashcards

Acute Setting Key Concepts Flashcards

1
Q

Describe an intracapsular hip fracture

A
  • Higher complication because of limited blood supply
  • Repair with compression screw (or 2-3) if non-displaced
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2
Q

Describe the Garden classification stages for sub-capital fractures

A
  • Predicts AVN
  • Stage 1: non-displaced incomplete
  • Stage 2: non-displaced complete
  • Stage 3: complete but incompletely displaced (unstable)
  • Stage 4: complete & completely displaced (unstable)
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3
Q

How is an intertrochanteric hip fracture repaired

A
  • Repaired by THA
  • Bipolar or unipolar
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4
Q

How is a subtrochanteric hip fracture repaired

A
  • Repaired with compression screw + intramedullary rod gamma nail
  • Compression screw & plate
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5
Q

Difference between a stable versus unstable pelvic fracture

A
  • Stable: only one break in the pelvic ring (can mobilize)
  • Unstable: 2 or more breaks in the ring or malalignment
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6
Q

What are the 9 do not want to miss serious pathologies

A
  • Major depression
  • Suicide risk
  • Femoral head & neck fractures
  • Cauda Equina Syndrome
  • Cervical myelopathy
  • AAA
  • DVT
  • PE
  • Atypical MI
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7
Q

What is the normal range for Troponin

A
  • <0.03 ng/mL
  • Used as criterion standard for defining & diagnosing myocardial infarction (MI)
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8
Q

Describe normal and abnormal BNP labs values

A
  • Normal: <100
  • Cardiac disease: 100-300
  • Mild sx and slight limitation during ordinary activity: >300
  • Marked limitation in activity due to sx: >600
  • Severe limitations & experience sx at rest: >900
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9
Q

What are the ranges for INR for normal and different diagnoses

A
  • Normal: 0.8-1.2
  • VTE/PE/A-fib: 2.0-3.0
  • Stroke: 2.0-2.5
  • Prosthetic heart valves: 2.5-3.5
  • Lupus anticoagulant: 3.0-3.5
  • Higher risk of bleeding: >3.6
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10
Q

What does D-Dimer test for

A
  • Test for possible VTE
  • Is a protein fragment produced when a blood clot gets dissolved into the body
  • Typically undetectable or at really low levels unless when a blood clot is being dissolved
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11
Q

What does CRP (C-reactive protein) test for

A
  • General marker of inflammation, acute or chronic
  • Elevated >10 is usually positive
  • Protein produced by the liver
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12
Q

What is the H&H rule of thumb

A
  • Hemoglobin and hematocrit should be 10 & 30
  • If lower use a sx based approach
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13
Q

What does hemoglobin assess and describe if trending up versus down

A
  • Assess anemia, blood loss, bone marrow suppression
  • Trending upwards: polycythemia
  • Trending downwards: anemia
  • Reference values: males -> 14-17; females -> 12-16
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14
Q

What does hematocrit assess for and describe if trending up versus down

A
  • Assess blood loss and fluid balance
  • Trending upwards: polycythemia
  • Trending downwards: anemia
  • Reference ranges: males -> 42-52%; females -> 37-47%
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15
Q

Lab values and normal ranges for liver function/hepatic panel

A
  • Serum Albumin (half life 21 days): 3.5-5.2
  • Serum pre-Albumin (half life 2 days): 19-39; causes if trending down include burns, malnutrition, & thyroid disease
  • Serum Bilirubin: normal -> 0.3-1.0; critical range -> >12
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16
Q

Lab values and normal ranges for kidney function

A
  • Blood urea nitrogen (BUN): 6-25; trending down = hepatic disease/malnutrition; trending up = high protein diet, renal failure, CHF
  • Serum Creatine; males -> 0.7-1.3; females -> 0.4-1.1; trending down = age/low muscle mass; trending up = renal disease, muscular dystrophy, rhabdomyolysis, dehydration
17
Q

Hepatic encephalopathy due to elevated NH3 (Ammonia/marker of kidney/liver function)) if untreated can progress to

A
  • Confusion
  • Disorientation
  • Sleepiness
  • Death
18
Q

What is the normal range for Ammonia (NH3)

A
  • 10-80
19
Q

Describe normal and abnormal lab values for diabetes

A
  • Glucose normal: 70-100; fasting (FPG) = 90-130
  • Glucose trending: up = FPG >126 or 2hr glucose >200 (causes DM, sepsis); down = <70 (causes excess insulin, brain injury, pituitary deficiency, Addison’s disease)
  • Hgb A1C normla: <5.7%; pre-DM = 5.7-6.4%; DM = >6.5% (poor glucose control)
20
Q

Describe normal and abnormal thyroid lab values

A
  • Thyroxine (T4) normal: 4.5-11.5
  • Triiodothyronine (T3) normal: 80-200
  • Thyroid stimulating hormone (TSH) normal: 0.3-3.0
  • Increased TSH AND decreased T4 = thyroid disease
  • Decreased TSH = pituitary disease
21
Q

Presentation of high T3&T4

A
  • Tremors
  • Nervous
  • Tachycardia
  • High metabolism
22
Q

Presentation of low T3&T4

A
  • Slow
  • Depressed
  • Ataxia
23
Q

How does Rhabdomyolysis present

A
  • Test strong MMT but Quick Fatigue
  • Appear “Well” but unable to Move w/o MAX assist
  • Labs: Way High CK levels
  • Elevated BUN as Kidney function declines
  • “Brown Tea” colored urine
24
Q

Illness script for Rhabdomyolysis

A
  • No defined LABS
  • Who gets it: trauma (crush injury), burns, ischemia, electrical, prolonged immobility (fall & unable to get back up)
  • Rapid onset can lead to kidney damage: high myoglobin 1st 24hrs and high CK next 2-5 days

Comprehensive Patient Care (4 decks)

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